Role of [18F]F-Fluciclovine PET/CT in Patients with Biochemical Recurrence of Prostate Cancer and Negative PSMA PET Results: A Single-Center Study
In brief
Fluciclovine PET detects recurrence in 56% after negative prostate-specific membrane antigen scans
In this prospective study of 50 patients with recurrent prostate cancer despite negative prostate-specific membrane antigen imaging, fluciclovine PET/CT found disease in 28; intended treatment plans changed for 71%. Detection rose with prostate-specific antigen levels, but the study was small and only 14 patients had a reference standard, so how reliably findings guide care remains uncertain.
- Journal
- Journal of nuclear medicine : official publication, Society of Nuclear Medicine (Q1)
- Published
- 29 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Laszlo Szidonya, Sebastian Obrzut, Jeong Y Lim, Emile Latour, Gagandeep Choudhary, Arthur Hung, et al.
- PMID
- 42957209
- DOI
- 10.2967/jnumed.126.272834
Why clinicians should know about it
- Picked for Urology (paper of the day, 1 November 2026): Evaluates complementary imaging for recurrent prostate cancer localization
Abstract
Our purpose was to evaluate whether [18F]F-fluciclovine PET/CT detects sites of disease in patients with biochemical recurrence (BCR) of prostate cancer and negative findings on prostate-specific membrane antigen (PSMA) PET and to assess its impact on intended management. Methods: In this prospective single-arm study (NCT05722925), 50 patients with BCR (prostate-specific antigen [PSA] ≥ 0.2 ng/mL) and negative findings on PSMA PET underwent [18F]F-fluciclovine PET/CT within 30 d of the previous imaging. Detection rate, distribution of disease, PSA-stratified analysis, management impact, and correct localization rate were assessed using descriptive statistics and exact CI. Results: [18F]F-fluciclovine PET had positive findings in 28 of 50 patients (56%; 95% CI, 41%-70%). Disease was confined to the prostate bed in 14 patients (50%), whereas 14 (50%) demonstrated nodal or distant metastases. Detection rate increased with PSA, from 44% at a PSA of 0.2-0.5 ng/mL to 100% at a PSA of 5 ng/mL or higher. The intended management changed in 71% of patients after the [18F]F-fluciclovine PET: 87% of patients with positive findings and 54% with negative findings. Among patients with an available reference standard (n = 14), all positive findings were confirmed to be true-positive. Conclusion: [18F]F-fluciclovine PET detected recurrent disease in over half of patients with negative PSMA PET findings and frequently altered management, supporting its complementary role in selected patients with BCR.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.